Prakash Pradeep, Ramachandran Rashmi, Tandon Nikhil, Kumar Rajeev
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Urol. 2020 Jan-Mar;36(1):21-25. doi: 10.4103/iju.IJU_186_19.
Minimally invasive approaches are the current standard of care for pheochromocytoma/paraganglioma (PC/PG) surgery. However, a number of patients still undergo open surgery for these tumors. We evaluated the current indications and outcomes of open surgery for PC/PG to define the role of this approach.
Data of patients undergoing PC/PG surgery between July 2008 and July 2017 were retrieved from our prospectively maintained electronic database and hospital records. Tumor characteristics, operative and recovery parameters, and complications were evaluated for indications of open procedure and outcomes.
During the study period, 106 patients underwent 124 procedures for PC/PG, including 18 simultaneous bilateral procedures. Surgeries included 102 adrenalectomies, 18 PG excisions, one partial adrenalectomy, and three partial cystectomies. Twenty-five (23.6%) patients (mean age 38.2 ± 16.1 years) underwent an open procedure, including four bilateral procedures. This included 16 adrenalectomies and 9 PG excisions. The indications for open surgery were unilateral large tumours (5; size 8-16, mean 11 cm), bilateral large tumours (2; size 6-10, mean 8.2 cm), retrocaval tumour extension (4), inter aortocaval PGs (8), Retro-mesenteric PG (1), concomitant procedures (3), and conversion from laparoscopy (2). Mean operative time was 217 ± 63.8 min, blood loss was 868 ± 734.2 ml, 11 patients required blood transfusion, and hospital stay was 6.44 ± 2.4 days. All these parameters were higher than for minimally invasive surgery (MIS) in this cohort. Three patients (12%) suffered a postoperative complication, and the rate of complications was not higher than MIS cohort (16%).
Open surgery was most often indicated for large tumors or those located in the inter-aortocaval region. Most such procedures require large incisions and possible hepatic mobilization on the right side. The procedures can be safely completed with few complications.
微创方法是嗜铬细胞瘤/副神经节瘤（PC/PG）手术的当前标准治疗方法。然而，仍有许多患者因这些肿瘤接受开放手术。我们评估了PC/PG开放手术的当前适应证和结局，以明确这种手术方式的作用。
从我们前瞻性维护的电子数据库和医院记录中检索2008年7月至2017年7月期间接受PC/PG手术的患者数据。评估肿瘤特征、手术和恢复参数以及并发症，以确定开放手术的适应证和结局。
在研究期间，106例患者接受了124例PC/PG手术，包括18例同期双侧手术。手术包括102例肾上腺切除术、18例副神经节瘤切除术、1例部分肾上腺切除术和3例部分囊肿切除术。25例（23.6%）患者（平均年龄38.2±16.1岁）接受了开放手术，包括4例双侧手术。这包括16例肾上腺切除术和9例副神经节瘤切除术。开放手术的适应证为单侧大肿瘤（5例；大小8 - 16 cm，平均11 cm）、双侧大肿瘤（2例；大小6 - 10 cm，平均8.2 cm）、腔静脉后肿瘤延伸（4例）、主动脉腔静脉间副神经节瘤（8例）、肠系膜后副神经节瘤（1例）、同期手术（3例）以及腹腔镜手术中转开腹（2例）。平均手术时间为217±63.8分钟，失血量为868±734.2毫升，11例患者需要输血，住院时间为6.44±2.4天。所有这些参数均高于该队列中的微创手术（MIS）。3例患者（12%）发生术后并发症，并发症发生率不高于MIS队列（16%）。
开放手术最常用于大肿瘤或位于主动脉腔静脉间区域的肿瘤。大多数此类手术需要大切口，右侧可能需要游离肝脏。手术可安全完成，并发症较少。
